First Lone Star Pharmacy Group IV LLC

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

FIRST LONE STAR PHARMACY GROUP IV LLC

Practice address

1246 S Highway 377
Ste 100
Pilot Point, TX 76258-4353

Phone

(940) 686-2218

Fax

(940) 686-9286

NPI assigned

Jan 27, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark Elliott

Title

Operations Manager

Phone

(214) 521-9991

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• AXTELL PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Justin Clay McConnell, CPHT

  • Pharmacy Technician
  • Pilot Point, TX
  • NPI 1366694507
  NPD (past)
• Rebecca Peterman, CPHT

  • Pharmacy Technician
  • Pilot Point, TX
  • NPI 1225280258
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718150400000",
    "number": "1174594451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1246 S HIGHWAY 377",
            "address_2": "STE 100",
            "city": "PILOT POINT",
            "state": "TX",
            "postal_code": "762584353",
            "telephone_number": "940-686-2218",
            "fax_number": "940-686-9286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1246 S HIGHWAY 377",
            "address_2": "STE 100",
            "city": "PILOT POINT",
            "state": "TX",
            "postal_code": "762584353",
            "telephone_number": "940-686-2218",
            "fax_number": "940-686-9286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST LONE STAR PHARMACY GROUP IV LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-27",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A",
        "authorized_official_last_name": "ELLIOTT",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "214-521-9991"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "29669",
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2146341",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "141751",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AXTELL PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• DS Health Development
• Cade Preston Edland
• Froilan Patrick Espinoza, M.D.
• Family NPS of North Texas
• Susan Ferguson, SLP
• First Lone Star Pharmacy Group IV LLC
• Courtni Fontenot
• Jacob Dainel Frost
• Caroline Frusha, MS, BCBA, LBA, CHW
• Garcia Healthcare Products, Inc

• All providers in Pilot Point, TX
• Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.